Resolved question:
I have been diagnosed with PRIMARY HYPOGONADISM a little over three months ago, and have been on Testosterone Replacement Therapy (via Androgel 1.62%, 2 pumps daily in the morning) for three months now. My question is primarily connected with the interest in increasing my dosage to optimum levels.
I took 3 blood tests PRE-TRT (before I started Androgel), and one blood test POST-TRT (2 months exactly after the start of the therapy)
Here are the results PRE-TRT (I posted all that was tested here, testosterone was tested in all three, but other things tested varied among the three tests as you can see) --
1st Test:
TESTOSTERONE (TOTAL) - [L] 55 ng/dL
PROLACTIN -------------- 15.3 ng/mL
LH ---------------------44 mIU/mL
2nd Test:
TESTOSTERONE (TOTAL)---[L] 99ng/dL
PROLACTIN -------------[H] 17.8 ng/mL
FSH ---------------------- 91 mIU/mL
LH ------------------------ 41 mIU/mL
3rd Test:
TESTOSTERONE (TOTAL) - 65 L
TESTOSTERONE (FREE) - 7 L
And here is the test result POST-TRT (2 months exactly after I started, I did this test, and it was 2 hours after I applied the gel, so I guess the Testosterone levels in my body were at their peak/highest point in the 24 hours cycle?):
TESTOSTERONE (TOTAL) - 413 ng/dL
TESTOSTERONE (FREE) - 81.4 pg/mL
ESTRADIOL - 22 pg/mL
So those are all the test results I have thus far.
This is what I would like to find out:
Being 25 years old and from what I read/hear I am biologically supposed to be in my prime (physically, mentally, and sexually), I would like to optimize the testosterone levels in my body so I can reap the full benefits of having testosterone. Keep in mind that my total testosterone level was 413 at its PEAK (approx. 2 hours after I applied the gel is when I had my blood drawn).
However, the Endocrinologist that I was seeing (he was the only one I've seen so far), said that increasing the testosterone levels to the high end of the normal range will not make any difference whatsoever regarding the positive effects, and that there is no medical justification for it anyways. This does not make any sense to me, because I feel that I am missing out on what I can achieve and live like with higher levels of T.
1. Isn't it true that total testosterone levels are averaged out by age group? That 413 ng/dL might be good for someone who is 50 years old, but not for someone who is 25, like me?
2. If I get an increased dosage in my prescription, will the increased testosterone result in the increase of the positive effects that I have subtly started to experience (muscle gain, less feelings of insecurity, more general confidence)? Is it really possible that raising the 413 ng/dL to 1000 ng/dL really wouldn't have any increase in the positive effects? This doesn't make a lot of sense to me. I really need a second opinion here.
Submitted:
4 Days
Category:
Endocrinologist
Hello and thankyou for approaching DoctorSpring with your query.
I have gone through your tests, and from the tests before treatment, it shows that you had primary hypogonadism.
What your doctor has said is right. Testosterone acts by a threshold level, which means that any level above a set minimum level of threshold works well, and no further amount of the increasing will help.
In addition excess of testosterone also has its side effects. In a patient using gel, the normal value is 400-700ng/dl . In your case you are withing normal range but you repeat your test in 3months to make sure the level is maintained.
Normaliztion of your testosterone levels will lead to an increase in libido, muscle gain, bone density and the confidence. Over a few months you will feel there is a further increase in the positive benefits that you are already experiencing.
Hence my advise to you is continue with the same dose and get your testosterone and LH levels repeated in another 3 months.
I hope this has helped. Feel free to follow up with any further query.
Thankyou
Thank you for answering my question, but I really need to clarify some things.
First of all, my total testosterone levels were in the MINIMUM normal range at their PEAK (2 hours after I applied the gel). You are telling me that it literally makes no difference whether the total testosterone is 400 ng/dL or 900 ng/dL?? Don't most 25 year olds have closer to 700-900 ng/dL total testosterone?? So, wouldn't it make sense to have the total testosterone level be normal for my age?
Second, when you wrote that "Over a few months you will feel there is a further increase in the positive benefits that you are already experiencing", do you mean that over the next 3 months I will experience an increase in benefits, meaning MORE than I already have experienced? Like that I haven't experienced all the effects of TRT yet? I thought it took only up to six weeks to feel the full effects of it (according to most of the literature on it, and I have been on it for about 13 weeks now).
Third, what happens if I FEEL like I have retracted in its positive effects, like they became less (which I do, this is the whole reason I brought up the question), even if the total testosterone IS within normal range? Is it not possible for me to have an optimal level (within normal range) that actually would make a difference?
Thank you for taking the time to fully answer my questions. I very much appreciate it.
Hello,
Please allow me to explain. First of all it is difficult to predict the levles when you are using a gel. So it is possible that you are having a higher T levels at some point of time.
You are seeing the T levels are a numerical concept. There are many more factors interplaying making it much complex. Imagine there is an cinema hall with 100 seats. Even if you allow 200 or 300 people inside the hall still only 100 people can still sit. Similarly once all the testosterone receptors are activated , there is no point in pumping more T. And remember we are supplementing for hypogonadism (so the normal self regulatory mechanisms of the body won't act fully).
Moreover, if there is increased testosterone it can lead on to lot of side effects like prostate enlargement, erythrocytosis, sleep apnoea and most importantly decreased sperm production. If you have noticed the FSH and LH values after T supplementation you might have noticed that they have actually come down. This is because of the negative feedback effect of T on FSH and LH. The hormone LH is required for normal sperm production. So if the T levels go high it can reduce LH levels thereby impairing sperm production. I am sure that you would not want that to happen.
Bottomline is your levels are good enough and there is no reason for concern here.
Hope this helps
Feel free to ask followups
Thank you
Okay, so I am starting to understand the concept now. I do have a few more questions though: If it is difficult to predict and manually control the levels of testosterone through the gel, which form of TRT would you recommend in order to more accurately predict the levels? How do I really know if ALL the testosterone receptors are activated? Is there any way to get an accurate indication of that? And lastly, if all the testosterone receptors are activated, then why do men who take steroids in order to highly increase their testosterone levels WAY ABOVE the maximum, have great increase in muscle size and development? I have no interest in taking steroids, I just want to know how this all works. Thank you.
Testosterone levels above normal is a good enough indication that the gel is working. There is no need for precise control (not possible either) . I generally prefer gels like AndroGel, Testim.
And exactly what ever you have mentioned in body builders is correct. You do not want to over do the testosterone dose and have side effects. You will be able to supersaturate the receptors, but then you will supress the LH levels causing negative side effects. The dose in needed can be adjusted by monitoring the blood values in long term.
Hope this helps
Thank you